Transforming Curiosity into Donation: Validating a Risk Prediction Index to Detect and Prevent Drop-Out in Potential Living Kidney Donors who are Racial/Ethnic Minorities

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PROJECT SUMMARY Approximately 1 in 7 US adults have chronic kidney disease (CKD), and >800,000 patients are in full kidney failure also called end-stage kidney disease (ESKD). The optimal treatment for ESKD is living kidney donor transplantation (LKDT); however, the standard of care continues to be ongoing dialysis, which has poor clinical outcomes in comparison to LKDT. CKD continues to increase among Hispanics and low-income patients. Black and Hispanic/Latino persons are respectively 3.1- and 1.3-times more likely than White persons to develop ESKD. Many individuals are curious about becoming a living donor, but some decide not to donate for unknown reasons. This prevents transplant centers and kidney organizations from improving their kidney donation process and tailoring donor care to overcome barriers, particularly for vulnerable and underserved populations. Drop-out is especially common for potential donors who are Black and Hispanic, specifically those who face greater socioeconomic challenges to donating, and those who are not biologically related to their kidney patients. Drop- out from these groups of potential donors contributes to known disparities in LKDT. To reduce disparities in living donation and increase LKDT, we propose a multi-step study that includes: Aim 1a: Early identification of patients of all races/ethnicities at higher risk of dropping out from the donor evaluation process via secondary data analyses of multiple regional and national donor databases. A tailored risk prediction index (LD-DROP) will be developed and tailored to characterize the risk of drop-out among potential donors at the time of initial screening or contact, including subgroup analyses by race, ethnicity, and socioeconomic status; Aim 1b: Validation of the LD-DROP index by prospectively tracking a large, diverse group of individuals presenting for living kidney donor evaluation at two large and geographically diverse transplant centers; Aim 2: Individual interviews of potential living donors of various race, gender, and level of risk for drop- out will be conducted to explore their decision-making and readiness to donate, what vulnerabilities and barriers to donation they face, and what financial, psychosocial, peer mentoring, and educational interventions might be most helpful for overcoming these barriers; Aim 3: An intervention to address donation barriers will be piloted for potential donors at high drop-out risk through a national online peer support program and transplant center- based education programs for potential living donors. Project deliverables will be made freely available nationwide via partnerships with the Scientific Registry of Transplant Recipients Living Donor Collective initiative and the National Kidney Foundation.